Provider Demographics
NPI:1073686200
Name:BERKMAN, KEVIN A (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:BERKMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-4031
Mailing Address - Country:US
Mailing Address - Phone:912-354-6767
Mailing Address - Fax:912-353-7431
Practice Address - Street 1:1101 E 51ST ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-4031
Practice Address - Country:US
Practice Address - Phone:912-354-6767
Practice Address - Fax:912-353-7431
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO005984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA387100OtherBLUE CROSS BLUE SHEILD
GA387100OtherBLUE CROSS BLUE SHEILD